Ballast Water Reporting Form

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1 Ballast Water Reporting Form Hello. The Ballast Water Reporting Form is an essential document for your vessel and crew. Ballast Water Management means accurate records that are contained in your Ballast Water Record Book, and meet the procedures of a Ballast Water Management Plan. This document is explained in detail with multiple sections on the screen to your right. These tutorials will take you through how to complete a Ballast Water Reporting Form. This form should be written in English and printed legibly. At the top of the form, you must first indicate if you are amending a previously submitted form. Amendments should be submitted if there are any differences between actual ballast discharges and discharge information reported previously. Now you can click on the View Media button to my left for a PDF of the Ballast Water Reporting Form. Click on the appropriate section to begin a detailed tutorial. Thank you. Section 1: Vessel Information We will start here, Section 1: Vessel Information. Fill out the name of the vessel clearly as well as the I.M.O. identification number. Next print the name of the registered owner or owners of the vessel, however if you are under charter enter the name of the operator. Fill out the gross tonnage of the vessel next, and finally enter the date and time of submission along with the country under whose authority the ship is operating. It is important to note that no abbreviations should be used in the flag section.

2 Section 2: Voyage Information Once we've reached section 2 it is important that no abbreviations be made. With that in mind please fill out the name of your port of destination, the scheduled arrival date, and agent used for the arrival port. Next you will print the last port and country at which the vessel called. Then print the next port and country at which the vessel will call. If this is unknown then it may be marked as unknown. Section 3: Ballast Water Usage and Capacity Here In section 3 you should fill out The Total Ballast Water on Board in terms of volume. In other words, what was the total volume of ballast water on board upon arrival into the port listed in section 2? Make sure you do not count potable water. Please include volume units, Meters cubed, Metric tons, Long tons, or short tons. Then Count the number of ballast tanks and holds with ballast when the vessel arrives at the Arrival Port listed in Section 2. Do not include tanks carrying only residual ballast water or sediment. Similarly fill out the total ballast water capacity. Volume is the maximum volume of ballast water carried while no cargo is on board. Units and total number of tanks should be filled out the same as above. Thank you

3 Section 4: Ballast Water Management Section 4 is where you will report all the information you have on your ballast water management plan as well as your implementation of Proper ballast water management. To begin record the total number of ballast water tanks that are going to be discharged. Count only tanks and holds with ballast to be discharged into waters or into an approved reception facility and report here. Count each tank separately, only include tanks with residual ballast if these will be ballasted locally and discharged into waters. Out of the tanks discharged, report how many underwent exchange here. If the tanks underwent alternative management, report the number of tanks here. You must also report the specific method used here. Describe methods used other than, empty/refill or Flow-through. For example a more appropriate description would be Salt Water Flushing. If there was no ballast treatment conducted onboard your vessel you must state the reason why in this section. This is where you record if you have a ballast water management plan. Check yes here if you have a written document on board, specific to your vessel, describing the procedure for ballast water management including safety and exchange procedures. If you do not have a ballast water management plan, check no. Report here if you implemented your ballast water management plan. If you select yes the crew should be able to demonstrate their familiarity with the plan during any inspection. Report weather or not you have a copy of the International Maritime Organization Ballast Water Guidelines on board the vessel here.

4 Section 5 and 6: Ballast Water History/Responsible Officers Name, Title, and Signature Section 5 is where you will report on all tanks that are being discharged. For all three sections, you will need to report the date, location, and volume of your ballast water. Please do not abbreviate the location. Starting in the Ballast Water Source section, list all tanks and holds that you plan to discharge into waters or approved facility. Write this out or use the codes listen below the table. If you are listing multiple ballast water sources in tanks do it separately. After reporting date, location, and volume, the fourth column is used to report the temperature of your ballast during uptake. Next, in the Ballast Water Management Practices section, if management practices took place over several dates, use the date that the management was completed. Report the percent exchange in the next column. Your percent exchange is the total volume added by empty/refill, or by flow-through divided by the capacity of your ballast tank or hold. If you are doing a flow through exchange, in order for it to be effective, your value should be at least 300 percent. The fifth column is used to report weather you used empty/refill, flowthrough, or an alternative method. In the last column estimate the sea height in meters at the time of ballast water exchange if this method is used. Make sure that this is not the combined height of the wind, sea, and swell, and does not refer to water depth. Last, in the Ballast Water Discharge section, remember not to use abbreviations for ports and for volume. Be sure not to enter a statement like, It depends on cargo operations, or something similar to this. If your proposed ballast water discharge is significantly different from the actual amount of water discharged an amended form must be submitted. Check with the designated ballast water officer or environmental officer on your vessel. The last column is where you will report your salinity in either parts per thousand or specific gravity.

5 Once all tanks and holds have been reported and information double checked, Move on to section six to print the responsible officer s, title, name, and then a signature. Source:

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